The use of immune checkpoint inhibitors(ICIs)has dramatically changed the treatment landscape of advanced non-small cell lung cancer (NSCLC), and have improved the survival outcomes of advanced patients while offering better overall safety compared to chemotherapy.However, due to immune senescence, the efficacy and safety of immunotherapy in elderly patients are different from those in non-elderly patients.Moreover, most clinical trials have limited data on elderly patients, and immunotherapy in the elderly population lacks high-level evidence-based medical support.This article introduces the theoretical basis of immunotherapy in the elderly population, summarizes clinical data on the efficacy and safety of immunotherapy for advanced NSCLC in the elderly, and analyses the immunotherapy for special subgroups of elderly patients, aiming to provide a reference basis for treating this population.The results showed that single-agent immunotherapy had good efficacy and safety in elderly patients with advanced NSCLC in the age group of 65-74 years, obtaining long-term survival benefits, However, the benefits of immunotherapy in the elderly population ≥75 years old remian unclear, and the outcomes of immunotherapy in the elderly ≥80 years old were poor.In addition, the performance status (PS) score of ≥2 was a significant factor in reducing the efficacy of single-agent immunotherapy in elderly patients.In addition, a pre-treatment PS score of ≥2 was an independent risk factor for reducing the efficacy of immunotherapy alone.Immunotherapy in combination with chemotherapy in the elderly has shown efficacy comparable to the overall population.However, there is an increased incidence of treatment-related adverse events(TRAEs)in patients ≥75 years of age.Dual-immunity combination therapies are not currently recommended for the treatment of advanced NSCLC in the elderly.Elderly patients with brain metastases have poor prognosis, and treatment may consider ICIs in combination with local radiotherapy.Basic research on how to improve the benefit of immunotherapy in elderly patients is also ongoing.In conclusion, the therapeutic prospect of immunotherapy in advanced NSCLC in the elderly is promising, and more exploration is needed in the future.

Objective To assess renal oxygen metabolism and iron deposition in type 2 diabetes mellitus(T2DM)patients using a combination of blood oxygen level-dependent(BOLD)and mDixon Quant techniques.Methods Clinical data of 58 T2DM patients from Tianjin First Central Hospital(September 2022-December 2023)were prospectively collected.According to urinary albumin-to-creation ratio(ACR),patients were divided into the normal albuminuria(NAU,ACR＜30 mg/g,n=35)group and the microalbuminuria(MAU,30 mg/g≤ACR＜300 mg/g,n=23)group.Thirty-three healthy volunteers were included as the control group during the same period.All participants underwent renal BOLD and mDixon Quant MRI to obtain cortical and medullary apparent relaxation rate(R2*)values.The differences of general data and image parameter values were compared between groups.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic efficacy of relevant parameters for early renal function changes.Results There were significant differences in body weight,estimated glomerular filtration rate(eGFR)and ACR between the control group,the NAU group and the MAU group(P＜0.01).The R2* value in renal cortex was lower than that in renal medulla(P＜0.01)in the same group.Apart from R2* value of BOLD renal cortex,which showed no significant difference between the three groups(P＜0.05),and the differences in the other parameters were statistically significant(P<0.05).When distinguishing between the control group and the NAU group,the NAU group and the MAU group,as well as between the control group and the early-stage T2DM(NAU+MAU)group,the combined two-sequence approach demonstrated higher area under the curve(AUCs)than any single sequence alone,with AUC value of 0.892(95%CI:0.809-0.975),0.785(95%CI:0.666-0.904)and 0.841(95%CI:0.756-0.926),respectively.Conclusion The combination of BOLD imaging with mDixon Quant enables noninvasive and quantitative assessment of alterations in renal oxygen metabolism and iron content in early-stage T2DM patients.The diagnostic performance of this combined approach surpasses that of individual methods.

Objective To assess renal oxygen metabolism and iron deposition in type 2 diabetes mellitus(T2DM)patients using a combination of blood oxygen level-dependent(BOLD)and mDixon Quant techniques.Methods Clinical data of 58 T2DM patients from Tianjin First Central Hospital(September 2022-December 2023)were prospectively collected.According to urinary albumin-to-creation ratio(ACR),patients were divided into the normal albuminuria(NAU,ACR＜30 mg/g,n=35)group and the microalbuminuria(MAU,30 mg/g≤ACR＜300 mg/g,n=23)group.Thirty-three healthy volunteers were included as the control group during the same period.All participants underwent renal BOLD and mDixon Quant MRI to obtain cortical and medullary apparent relaxation rate(R2*)values.The differences of general data and image parameter values were compared between groups.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic efficacy of relevant parameters for early renal function changes.Results There were significant differences in body weight,estimated glomerular filtration rate(eGFR)and ACR between the control group,the NAU group and the MAU group(P＜0.01).The R2* value in renal cortex was lower than that in renal medulla(P＜0.01)in the same group.Apart from R2* value of BOLD renal cortex,which showed no significant difference between the three groups(P＜0.05),and the differences in the other parameters were statistically significant(P<0.05).When distinguishing between the control group and the NAU group,the NAU group and the MAU group,as well as between the control group and the early-stage T2DM(NAU+MAU)group,the combined two-sequence approach demonstrated higher area under the curve(AUCs)than any single sequence alone,with AUC value of 0.892(95%CI:0.809-0.975),0.785(95%CI:0.666-0.904)and 0.841(95%CI:0.756-0.926),respectively.Conclusion The combination of BOLD imaging with mDixon Quant enables noninvasive and quantitative assessment of alterations in renal oxygen metabolism and iron content in early-stage T2DM patients.The diagnostic performance of this combined approach surpasses that of individual methods.

The use of immune checkpoint inhibitors(ICIs)has dramatically changed the treatment landscape of advanced non-small cell lung cancer (NSCLC), and have improved the survival outcomes of advanced patients while offering better overall safety compared to chemotherapy.However, due to immune senescence, the efficacy and safety of immunotherapy in elderly patients are different from those in non-elderly patients.Moreover, most clinical trials have limited data on elderly patients, and immunotherapy in the elderly population lacks high-level evidence-based medical support.This article introduces the theoretical basis of immunotherapy in the elderly population, summarizes clinical data on the efficacy and safety of immunotherapy for advanced NSCLC in the elderly, and analyses the immunotherapy for special subgroups of elderly patients, aiming to provide a reference basis for treating this population.The results showed that single-agent immunotherapy had good efficacy and safety in elderly patients with advanced NSCLC in the age group of 65-74 years, obtaining long-term survival benefits, However, the benefits of immunotherapy in the elderly population ≥75 years old remian unclear, and the outcomes of immunotherapy in the elderly ≥80 years old were poor.In addition, the performance status (PS) score of ≥2 was a significant factor in reducing the efficacy of single-agent immunotherapy in elderly patients.In addition, a pre-treatment PS score of ≥2 was an independent risk factor for reducing the efficacy of immunotherapy alone.Immunotherapy in combination with chemotherapy in the elderly has shown efficacy comparable to the overall population.However, there is an increased incidence of treatment-related adverse events(TRAEs)in patients ≥75 years of age.Dual-immunity combination therapies are not currently recommended for the treatment of advanced NSCLC in the elderly.Elderly patients with brain metastases have poor prognosis, and treatment may consider ICIs in combination with local radiotherapy.Basic research on how to improve the benefit of immunotherapy in elderly patients is also ongoing.In conclusion, the therapeutic prospect of immunotherapy in advanced NSCLC in the elderly is promising, and more exploration is needed in the future.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the changing distribution and antibiotic resistance profiles of clinical isolates of Staphylococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Staphylococcus according to the unified protocol of CHINET(China Antimicrobial Surveillance Network)using disk diffusion method and commercial automated systems.The CHINET antimicrobial resistance surveillance data from 2015 to 2021 were interpreted according to the 2021 CLSI breakpoints and analyzed using WHONET 5.6.Results During the period from 2015 to 2021,a total of 204,771 nonduplicate strains of Staphylococcus were isolated,including 136,731(66.8％)strains of Staphylococcus aureus and 68,040(33.2％)strains of coagulase-negative Staphylococcus(CNS).The proportions of S.aureus isolates and CNS isolates did not show significant change.S.aureus strains were mainly isolated from respiratory specimens(38.9±5.1)％,wound,pus and secretions(33.6±4.2)％,and blood(11.9±1.5)％.The CNS strains were predominantly isolated from blood(73.6±4.2)％,cerebrospinal fluid(12.1±2.5)％,and pleural effusion and ascites(8.4±2.1)％.S.aureus strains were mainly isolated from the patients in ICU(17.0±7.3)％,outpatient and emergency(11.6±1.7)％,and department of surgery(11.2±0.9)％,whereas CNS strains were primarily isolated from the patients in ICU(32.2±9.7)％,outpatient and emergency(12.8±4.7)％,and department of internal medicine(11.2±1.9)％.The prevalence of methicillin-resistant strains was 32.9％in S.aureus(MRSA)and 74.1％in CNS(MRCNS).Over the 7-year period,the prevalence of MRSA decreased from 42.1％to 29.2％,and the prevalence of MRCNS decreased from 82.1％to 68.2％.MRSA showed higher resistance rates to all the antimicrobial agents tested except trimethoprim-sulfamethoxazole than methicillin-susceptible S.aureus(MSSA).Over the 7-year period,MRSA strains showed decreasing resistance rates to gentamicin,rifampicin,and levofloxacin,MRCNS showed decreasing resistance rates to gentamicin,erythromycin,rifampicin,and trimethoprim-sulfamethoxazole,but increasing resistance rate to levofloxacin.No vancomycin-resistant strains were detected.The prevalence of linezolid-resistant MRCNS increased from 0.2％to 2.3％over the 7-year period.Conclusions Staphylococcus remains the major pathogen among gram-positive bacteria.MRSA and MRCNS were still the principal antibiotic-resistant gram-positive bacteria.No S.aureus isolates were found resistant to vancomycin or linezolid,but linezolid-resistant strains have been detected in MRCNS isolates,which is an issue of concern.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

OBJECTIVE To establish the fingerprint of Gegenqinlian tablets and determine the content of eleven components(3’-hydroxy puerarin, puerarin, 3’-methoxy puerarin, daidzin, baicalin, palmatine hydrochloride, berberine hydrochloride, scutellarin, baicalein, ammonium glycyrrhizinate and wogonin) by quantitative analysis of multi-components by single-marker(QAMS).METHODS Ten batches of Gegenqinlian tablets were determined by HPLC and a common fingerprint was established. Baicalin was selected as internal reference. The relative correction factors of the component with 3’-hydroxy puerarin, puerarin, 3’-methoxy puerarin, daidzin, palmatine hydrochloride, berberine hydrochloride, scutellarin, baicalein, ammonium glycyrrhizinate and wogonin were calculated and their contents were calculated. The feasibility and scientificity of QAMS was evaluated by comparison on the results between the measured value and calculation value by external standard method and QAMS. The chromatographic separation was performed on ananalytical column of Waters Xbridge-C18(250 mm× 4.6 mm, 5 μm) with gradient elution, the mobile phase was acetonitrile 0.1% phosphoric acid aqueous solution, at a flow rate of 1.0 mL·min-1. The column temperature was 30 ℃ and the detection wavelength was 260 nm.RESULTS There were 20 peaks in 10 batches of Gegenqinlian tablets and 11 chemical constituents were identified. The similarity of 10 batches of Gegenqinlian tablets was >0.97. The linear range of 3’-hydroxy puerarin, puerarin, 3’-methoxy puerarin, daidzin, baicalin, palmatine hydrochloride, berberine hydrochloride, scutellarin, baicalein, ammonium glycyrrhizinate and wogonin were 0.056 6-2.830 2, 0.241 2-12.058 6, 0.128 0-6.401 0, 0.059 7-2.983 5, 0.242 7-12.134 9, 0.045 7-2.285 7, 0.192 8-9.641 0, 0.043 3-2.167 0, 0.018 0-0.900 2, 0.021 0-1.048 4, 0.011 5-0.575 4 μg (r2= 0.999 6-1.000) respectively. The average recovery were 100.23%, 102.01%, 101.66%, 102.73%, 100.17%, 98.45%, 98.41%, 100.95%, 101.85%, 97.97%, 100.09%(RSD=1.24%-2.57%, n=6) respectively. The relative correction factors of 3’-hydroxy puerarin, puerarin, 3’-methoxy puerarin, daidzin, palmatine hydrochloride, berberine hydrochloride, scutellarin, baicalein, ammonium glycyrrhizinate and wogonin were 0.860 4, 0.605 3, 0.850 9, 0.582 8, 0.557 1, 0.498 6, 0.767 2, 0.652 1, 2.608 1, 0.545 2 respectively. RAD between QAMS method and external standard method were 0.03%-2.12%. CONCLUSION The combination of QAMS and fingerprint can provide reference for the quantitative determination and quality control of Gegenqinlian tablets.

Objective:To noninvasively evaluate the clinical value of early renal function changes in patients with type 2 diabetes mellitus (T2DM) using blood oxygenation level dependent (BOLD) and arterial spin labeling (ASL) MRI.Methods:A total of 63 T2DM patients from Tianjin First Central Hospital from September 2019 to May 2022 were prospectively collected, 30 healthy volunteers (control group) were collected during the same period. According to albumin creatinine ratio (ACR), patients with T2DM were divided into normal albuminuria (NAU, ACR<30 mg/g) group and microalbuminuria (MAU, 30 mg/g≤ACR≤300 mg/g) group, there were 35 and 28 cases respectively. All subjects underwent abdominal BOLD and ASL scans. The values of renal cortical and medullary apparent relaxation rate (R 2*) and renal cortical renal blood flow (RBF) were measured. One-way ANOVA was used to compare the differences in R 2* and RBF among the three groups. Receiver operating characteristic curve was used to analyze relevant parameters to identify the diagnostic effectiveness of each group, and area under the curve (AUC) was compared by Z-test. Results:There were significant differences in renal medullary R 2* and renal cortical RBF among the control group, NAU group and MAU group ( F=45.83, 34.15, P<0.001). There was no significant difference in renal cortical R 2* ( F=2.98, P=0.056). In differentiating the control group from the NAU group, the AUC of renal medullary R 2*, renal cortical RBF and their combined parameters were 0.921 (95%CI 0.827-0.973), 0.704 (95%CI 0.578-0.811), 0.964 (95%CI 0.885-0.994), respectively. The AUC of combined parameters was significantly different from renal cortical RBF ( Z=4.07, P<0.001), but not from renal medullary R 2* ( Z=1.57, P=0.117). In differentiating the NAU from the MAU group, the AUC were 0.898 (95%CI 0.796-0.960), 0.919 (95%CI 0.823-0.973), 0.985 (95%CI 0.881-0.994), respectively. The AUC of combined parameters was significantly different from renal medullary R 2* and renal cortical RBF ( Z=2.39, P=0.017; Z=2.20, P=0.028). Conclusions:The changes of renal oxygenation level and blood flow in early stage of T2DM patients can be evaluated noninvasively and quantitatively using BOLD and ASL. Renal medullary R 2* combined with renal cortex RBF shows better diagnostic efficacy for early renal function changes in diabetes than each single index.